Last week’s brutal heat wave is now linked a total of 74 deaths, including 34 in Montreal, most of them elderly men and women living alone in sweltering apartments, and many with underlying health conditions.

Following a few days of cooler temperatures, next weekend is to begin another string of searing hot days, according to weather forecast reports.

David Kaiser, a physician with Montreal’s health department, said at risk are small children, the elderly and those with health conditions, often taking medications that affect their ability to recognize thirst, which means they cannot get rid of the accumulated heat in their bodies. “And after three or four days of heat, people’s coping mechanisms are just overwhelmed,” he said.

That’s a different scenario, for example, than an athlete marathon runner whose body temperature jumps from 37 to 42 degrees during an hour of exercise and suffers a deadly heat stroke, he said.

“If you can’t get out of the heat, that ends up being a big problem,” Kaiser said, especially for the at-risk fragile population. “Heat stress is often what tends to put them over the edge. They may have been doing fine with their heart disease — and then you put four or five days of heat on that and their heart fails because the stress on the system is so important.”

Following the 106 deaths related to the 2010 Montreal heat wave, the province began keeping real-time tabs to be able to intervene more rapidly based on reports of “potential heat-related deaths” from a spike in ambulance calls and admissions to hospital emergency rooms. That’s when an emergency phase response is launched, for example, going door to door, and opening urban cooling stations with air conditioning.

The final death toll in 2010 was based on an in-depth evaluation of hospital charts, coroner’s reports and all other records currently not available in real time, he said. A similar report will be done at the end of this summer for the current heat wave, and only then will the two heat waves be compared.

Meanwhile, officials in Ontario, which had similar heat wave, said that heat-related deaths are usually declared by the coroner.

However, the coroner does not investigate every heat-related death “as many of them don’t come to the attention of our office,” said Cheryl Mahyr, manager of the Ontario Chief Coroner’s office.

Generally, a reported death would be investigated when described as accidental, unnatural and/or sudden and unexpected.

“Deaths of persons (many of whom may be elderly) with one or more medical conditions that may make them more sensitive to the effects of hot weather and perhaps, lack of access to air conditioning, may never come to our attention as their deaths would be categorized as natural,” she said.

As far as Quebec health authorities are concerned, none of the deaths during the extreme heat wave occurred in a public long-term care nursing home, a centre d’hébergement et de soins de longue durée (CHSLD) or in a hospital.

However, staff and patients in some Montreal-area nursing facilities and hospitals have complained of suffocating conditions. Patients have been told to bring in their own fans and air conditioners.

On Monday, in response to an health advocate calling for an independent investigation into any sudden deaths, an association of private nursing homes owners said it was “horrified” by what it said was a scandal-in-the-making.

“It is indecent, misplaced and dangerous to suggest that CHSLDs are hiding deaths linked to the heat wave,” Annick Lavoie, head of the Association des établissements privés conventionnés, said in a statement.

The association accused patients-rights advocate Paul Brunet, head of the Conseil pour la protection des malades, of attempting to create a scandal where there isn’t one.

But Brunet said he’s simply calling for an independent investigation into whether people died because of extreme heat in rooms without air conditioners.

Brunet appealed to families to signal to the coroner any “sudden and rapid degradation of health leading to death” in public nursing homes between June 28 and July 5.

Brunet chided government for failing to provide for patients while giving doctors annual salary increases of eight per cent.

“Don’t tell me you don’t have the money to put air conditioners in patients’ rooms. These are facilities where people live, and these should be decent living conditions,” Brunet said, while most nursing home administrators work in air-conditioned offices.

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